Preterm Contractions Checklist

Obstetrics
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Preterm Contractions Checklist
1. Is the gestational age less than 37 weeks?
[select value="Unknown|No|Yes"] <-- Are dates certain?
[select value="Unknown|No|Yes"] <-- Established by LMP or early ultrasound?
[textarea]
2. Are the membranes ruptured?
[select value="Unknown|No|Yes"] <-- History of leaking fluid?
[select value="Unknown|No|Yes"] <-- Positive nitrazine test result?
[select value="Unknown|No|Yes"] <-- Ferning of fluid on microscopy?
[select value="Unknown|No|Yes"] <-- Positive amniotic protein test result?
[select value="Unknown|No|Yes"] <-- Ultrasound assessment shows low amniotic fluid?
[select value="Unknown|No|Yes"] <-- Ultrasound-guided transabdominal instillation of indigo carmine dye into the amniotic sac, if available, shows dye outside the amniotic sac?
[textarea]
3. Is the patient in labor?
[select value="Unknown|No|Yes"] <-- Regular contractions
[select value="Unknown|No|Yes"] <-- Progressive dilation and cervical effacement?
[textarea]
4. Is there an infection?
[select value="Unknown|No|Yes"] <-- Group B streptococcus carrier status?
[select value="Unknown|No|Yes"] <-- Urinary tract infection?
[select value="Unknown|No|Yes"] <-- Bacterial vaginosis?
[select value="Unknown|No|Yes"] <-- Trichomoniasis?
[select value="Unknown|No|Yes"] <-- Gonorrhea?
[select value="Unknown|No|Yes"] <-- Chlamydia?
[textarea]
5. What is the likelihood that the patient will deliver prematurely?
[select value="Unknown|No|Yes"] <-- Fetal fibronectin test negative?
[select value="Unknown|No|Yes"] <-- Cervical length of at least 3 cm on ultrasonagraphy?
[textarea]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"]
Reference:
[link url="https://www.ncbi.nlm.nih.gov/pubmed/20148502" memo="#1"] Sayres WG Jr. Preterm labor. Am Fam Physician. 2010 Feb 15;81(4):477-84. [/conditional]
Preterm Contractions Checklist
1. Is the gestational age less than 37 weeks?
<-- Are dates certain?
<-- Established by LMP or early ultrasound?

2. Are the membranes ruptured?
<-- History of leaking fluid?
<-- Positive nitrazine test result?
<-- Ferning of fluid on microscopy?
<-- Positive amniotic protein test result?
<-- Ultrasound assessment shows low amniotic fluid?
<-- Ultrasound-guided transabdominal instillation of indigo carmine dye into the amniotic sac, if available, shows dye outside the amniotic sac?

3. Is the patient in labor?
<-- Regular contractions
<-- Progressive dilation and cervical effacement?

4. Is there an infection?
<-- Group B streptococcus carrier status?
<-- Urinary tract infection?
<-- Bacterial vaginosis?
<-- Trichomoniasis?
<-- Gonorrhea?
<-- Chlamydia?

5. What is the likelihood that the patient will deliver prematurely?
<-- Fetal fibronectin test negative?
<-- Cervical length of at least 3 cm on ultrasonagraphy?

display/hide references
Result - Copy and paste this output:

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